Kramer Kim, Pandit-Taskar Neeta, Zanzonico Pat, Wolden Suzanne L, Humm John L, DeSelm Carl, Souweidane Mark M, Lewis Jason S, Cheung Nai-Kong V
Department of Pediatrics, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, Box 249, New York, NY, 10065, USA,
J Neurooncol. 2015 Jun;123(2):245-9. doi: 10.1007/s11060-015-1788-z. Epub 2015 May 6.
Radionecrosis is a potentially devastating complication of external beam radiotherapy (XRT). Intraventricular compartmental radioimmunotherapy (cRIT) using (131)I-3F8 or (131)I-8H9 can eradicate malignant cells in the CSF. The incidence of radionecrosis using cRIT (131)I based intraventricular radioimmunotherapy, when used alone or in combination with conventional craniospinal CSI-XRT is unknown. We retrospectively analyzed the incidence of radionecrosis in two cohorts of pediatric patients treated with both CSI-XRT and cRIT at MSKCC since 2003: patients with metastatic CNS neuroblastoma (NB) and medulloblastoma (MB). 94 patients received both CSI-XRT and cRIT, two received cRIT alone, median follow up 41.5 months (6.5-124.8 months). Mean CSI-XRT dose was 28 Gy (boost to the primary tumor site up to 54 Gy) in the MB cohort, and CSI XRT dose 18-21 Gy (boost to 30 Gy for focal parenchymal mass) in the NB cohort. For MB patients, 20 % had focal re-irradiation for a second or more subsequent relapse, mean repeat-XRT dose was 27.5 Gy; seven patients with NB had additional focal XRT. Median CSF cRIT dose was 18.6 Gy in the MB cohort and 32.1 in the NB cohort. One asymptomatic patient underwent resection of 0.6-cm hemorrhagic periventricular white-matter lesion confirmed to be necrosis and granulation tissue, 2.5 years after XRT. The risk of radionecrosis in children treated with XRT and cRIT appears minimal (~1 %). No neurologic deficits secondary to radionecrosis have been observed in long-term survivors treated with both modalities, including patients who underwent re-XRT. Administration of cRIT may safely proceed in patients treated with conventional radiotherapy without appearing to increase the risk of radionecrosis.
放射性坏死是外照射放疗（XRT）潜在的严重并发症。使用（131）I - 3F8或（131）I - 8H9进行脑室内分区放射免疫治疗（cRIT）可根除脑脊液中的恶性细胞。单独使用或与传统的全脑脊髓照射（CSI）-XRT联合使用基于cRIT（131）I的脑室内放射免疫治疗时放射性坏死的发生率尚不清楚。我们回顾性分析了自2003年以来在纪念斯隆凯特琳癌症中心（MSKCC）接受CSI-XRT和cRIT治疗的两组儿科患者中放射性坏死的发生率：转移性中枢神经系统神经母细胞瘤（NB）和髓母细胞瘤（MB）患者。94例患者接受了CSI-XRT和cRIT治疗，2例仅接受了cRIT治疗，中位随访时间为41.5个月（6.5 - 124.8个月）。在MB队列中，CSI-XRT的平均剂量为28 Gy（对原发肿瘤部位的增敏剂量高达54 Gy），在NB队列中，CSI-XRT剂量为18 - 21 Gy（对局灶性实质肿块增敏至30 Gy）。对于MB患者，20%因第二次或更多次后续复发接受了局部再照射，平均重复XRT剂量为27.5 Gy；7例NB患者接受了额外的局部XRT。MB队列中脑脊液cRIT的中位剂量为18.6 Gy，NB队列中为32.1 Gy。1例无症状患者在XRT后2.5年接受了手术切除，切除的0.6 cm出血性脑室周围白质病变经证实为坏死和肉芽组织。接受XRT和cRIT治疗的儿童发生放射性坏死的风险似乎极小（约1%）。在接受这两种治疗方式的长期存活者中，包括接受再XRT治疗的患者，未观察到继发于放射性坏死的神经功能缺损。在接受传统放疗的患者中进行cRIT治疗可能是安全的，且似乎不会增加放射性坏死的风险。
